AB0791 EVALUATION OF THE EFFICACY AND COMPLICATIONS OF PLASMA EXCHANGE IN ANCA-ASSOCIATED VASCULITIS: RESULTS OF PROPENSITY SCORE MATCHING ANALYSIS IN HIGH-RISK PATIENTS
Authors: B. Ince, M. Bektas, B. Celik, S. Yüce, Y. Yalçinkaya, B. Artim-Esen, A. Gül, S. K. Besisik, M. Inanc
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Therapeutic plasma exchange (PE) is applied in addition to standard induction therapy for patients with severe organ or system involvement in ANCA-associated vasculitis (AAV). However, prognostic significance of this approach is questioned. <h3>Objectives</h3> We aimed to evaluate both short- and long-term efficacy and safety of PE in our established single center cohort. <h3>Methods</h3> In this study, we evaluated the clinical and laboratory data of 128 patients diagnosed with AAV between 2011 and 2021. Data of patients with GFR &lt;50 ml/min with or without diffuse alveolar hemorrhage (DAH) at the time of admission were included into the analysis. Disease activity, laboratory and follow-up data of patients who underwent PE were compared with those who did not. The analyses were repeated in the groups formed after the propensity score matching (PSM) performed according to the presence of DAH, age, gender, baseline GFR and BVAS scores. <h3>Results</h3> Seventy-one (55.5%) patients (F/M: 32/39, mean age± SD: 54.6±12.9) were included into the study. Thirty-nine (54.9%) patients had C-ANCA/PR3, 29 (40.8-%) patients had p-ANCA/MPO positivity. The mean follow-up was 53.6±34.7 months. In addition to high-dose corticosteroid treatment during induction therapy, IV cyclophosphamide (CYC) was used in 66 (92.9%) and rituximab was used in 3 (4.3%) patients. PE was applied in 33 (46.5%) patients. All patients who underwent PE had received CYC for induction. The median number of PE sessions was 7 (2-12). Fresh frozen plasma was used in 22 patients (66.6%) and albumin was used in 11 patients (33.3%). In patients who underwent PE, DAH and GFR&lt;50ml/min were present in 20(28.2%) and 64(90.1%) patients, respectively. Hypotension in 3 patients, hypocalcemia in one, catheter-related thrombosis in one and transfusion reactions in 2 patients were recorded as short-term complications. In patients who underwent PD, the remission rate was low in the sixth month, and the development of severe infections and ESRD was high in the first year (Table 1). In the PSM analysis, creatinine values during the follow-up were higher in the patients who underwent PE. In both analyses, remission rates were lower in the PE group at six months, and the number of serious infections, ESRD development, and total VDI score were higher at twelve months. <h3>Conclusion</h3> In this retrospective study, positive effect of PE on remission and mortality in AAV could not be demonstrated. Efficacy against the development chronic renal failure and ESRD was also not observed. Despite low short-term complication rates related to PE, increased risk of severe infection which became evident with PSM analysis, was remarkable. In conclusion, these findings raise concern and should lead to careful patient selection for PE. Although an important therapeutic option for AAV patients with severe disease, limited long term benefits should be well balanced with risks. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.